PROJECT SUMMARY/ABSTRACT There is a need to understand how the results of the National Lung Screening Trial (NLST) and the U.S. Pre- ventive Services Task Force (USPSTF) guidelines will impact the use of low-dose computed tomography (LDCT) for lung cancer screening in the general population. Given the high incidence and mortality rates of lung cancer, developing evidence on the utility of a screening test that can reduce lung cancer mortality will likely lead to a significant improvement in public health. Our long-term goal is to examine the delivery, quality and outcomes of lung cancer screening in North Carolina by utilizing prospective population-based lung cancer screening data that captures patient, radiologist, and pathology information to inform clinical practice. The objective of this application is to evaluate the extent to which disparities in intermediate lung cancer screening outcomes exist. We plan to accomplish this objective by pursuing the following four specific aims: (1) Deter- mine the agreement between radiologists' use of the lung imaging reporting and data system (Lung-RADS) assessment code and follow-up recommendations with the American College of Radiology (ACR) guidelines; (2) Evaluate recall rates of lung cancer screening with LDCT by patient socio-demographics and risk factors; (3) Compare rates of follow-up receipt after a positive lung cancer screening test result by patient socio- demographics and risk factors; (4) Perform a data linkage between lung cancer screening data and lung can- cer outcomes from the North Carolina Central Cancer Registry (NCCCR) to examine false positive rates. With the USPSTF recommending LDCT for lung cancer screening in high-risk individuals, there is a growing need to monitor the screening experience as academic centers and community practices begin to adopt this technolo- gy. This is an innovative study that uses established methods in population-based registry development to ex- plore an emerging clinically relevant cancer screening area for which limited data exist. The proposed research is significant because it will provide evidence on lung cancer screening with LDCT in a general population to inform the delivery, quality, and outcomes of lung cancer screening as it diffuses into clinical practice.